THE UNIVERSITY OF TROMSØ UIT
FACULTY OF HEALTH SCIENCES THE REGIONAL CENTRE FOR CHILD AND ADOLESCENT MENTAL HEALTH (RKBU North)
Interventions to Prevent the Trans-Generational Transmission of Mental Health Problems for Children of Mentally Ill Parents Camilla Lauritzen1, Charlotte Reedtz1, Karin van Doesum1,2 & Monica Martinussen1, 1 Regional Center For Child and Youth Mental Health and Welfare (RKBU), University of Tromsø, Norway and 2Radboud University Nijmegen, The Netherlands Contact information: Camilla Lauritzen, RKBU North, University of Tromsø, N-9037 Tromsø, Norway. E-mail:
[email protected] Telephone: +47 77645871
BACKGROUND
In Scandinavia, there have been ongoing efforts the past decade to increase knowledge and awareness about the risk factors of having parents with mental health problems (E.g. Solantaus, Paavonen, Toikka, & Punamaki, 2010). These risk factors have been thoroughly documented internationally and studies have concluded that children of parents with a mental illness are at risk of developing social and mental health problems themselves (Beardslee, Versage & Gladstone, 1998; Hosman, van Doesum, & van Santvoort, 2009; Reupert & Maybery, 2007). Subsequently, Norway has changed health legislation and routines in order to make sure these children are identified and given necessary support, as a national effort to prevent the transmission of mental health problems from one generation to the next (The Ministry of Health and Care Services, 2009). However, studies have shown that there is a gap between what is known about consequences of parental mental illness and what is done in the field of practice (Proctor, Landsverk, Aarons, Chambers, Glisson & Mittman, 2008; Maybery & Reupert, 2006; Lauritzen, Reedtz, van Doesum, & Martinussen, 2013). The aim of the current study was to explore the challenges of filling this gap in the Norwegian context.
RESULTS
In order to achieve changes in skills, organizational capacity and culture; the health care services need to integrate long-term multilevel implementation strategies. Results showed that the implementation of new routines in adult mental health care is coming along extremely slowly, and that there are several barriers within the adult mental health services related to including a focus on children in the treatment of mentally ill parents. The results of this study also showed that even though health legislation has been changed in order to safeguard children of mentally ill parents, there is still a need for clear and effective strategies to fully incorporate efforts to prevent the trans-generational transmission of mental health problems within families. Detailed results are displayed in table 1 (challenges) and table 2 (important factors to succeed).
DISCUSSION Although this study was conducted approximately 1.5 years after the law became effective, it is evident that the implementation of a child perspective into adult mental health care is coming along extremely slowly. The national strategy has been to inform the workforce about the new legislation, but in our view this does not even have the potential to change clinical practice. The intention behind the law was to create an innovation in terms of prevention of trans-generational transmission of mental health problems. It is important to recognize that in order to achieve changes in skills, organizational capacity and culture; the health care services need to integrate long-term multilevel implementation strategies (Fixsen et. al., 2005; Rogers, 1995). Authorities and health enterprises need to take into account the fact that dissemination of information so far, has not resulted in positive implementation outcomes (i.e. changes in practitioner behavior). The results of this study underlines the fact that even though health legislation has been changed in order to safeguard children of mentally ill parents, there is still a need for clear and effective strategies to fully incorporate a child perspective into adult mental health care.
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We need an on-going development of knowledge and skills on Foto: : Colourbox.com
this area in every ward at the hospital. Courses and supervision are very important elements. I would also like role-play sessions, because I am afraid of making mistakes and do wrong things that may harm the children.
METHODS
STUDY LIMITATIONS
The justification for labeling open-ended items as qualitative data when they were collected through quantitative data collection methods (survey design) may be regarded as a limitation (Slattery, Voelker, Nussenbaum, Rich, Paniello & Neely 2011). However, despite not having been gathered in an interview situation, the open-ended questions generate qualitative text-data that needs to be analyzed using qualitative methods (Poncheri, Lindberg, Foster Thompson & Surface, 2008). Another limitation of this study was the response rate. Only part of the sample answered, and this may cause the results to be biased.
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The lack of routines is one challenge, but the most important
is the established bad culture within adult psychiatry when it comes to this matter. The culture seems to be “do not get in-
volved, it is not your business.
Challenges to identifying and providing support for children of mentally ill parents Sub-categories:
Issues:
Organizational challenges
Lack of time Lack of routines Lack of training Lack of management support Lack of economic resources Lack of tools
Staff related challenges
Lack of interest Lack of commitment Lack of knowledge Lack of experience Lack of capacity High turn-over staff
Child and family related challenges
Children and families reluctant
Contextual challenges
Geography Confidentiality issues
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We need training and education about how to approach the
parents. We also need knowledge about child development, so
we know what risk factors to look for. Table 2. (N = 183) Important factors in order to provide support to children of mentally ill parents Sub-categories:
Issues:
Factors related to management and organization
Time Management support Economy Tools, routines, systems Training, education Sufficient staff
Factors related to the staff
Experience Stability personnel group Support from colleagues Interest and commitment Confident personnel Groups for supervision and support
Factors related to children and families
Assessment of the child’s needs Get in position to talk to families Establish relation and trust
Factors related to context
Legislation, Obligation Geographical challenges Collaboration with other agencies Child responsible staff
eardslee, W. R., Versage, E. M., & Gladstone, T. R. G. (1998). Children of affectively ill parents: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 1134-1141. Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation Research: A synthesis of the literature. University of South Florida, Tampa. Downloaded from http://cfs.cbcs.usf.edu/publications/detail.cfm?id=137 on the 20th of October, 2011. Hosman, C. M. H., van Doesum, K. T. M., & van Santvoort, F. (2009). Prevention of emotional problems and psychiatric risks in children of parents with a mental illness in the Netherlands:I. The scientific basis to a comprehensive approach. Australian e-Journal for the Advancement of Mental Health (AeJAMH), 8, 222-226. http://auseinet.com/journal Lacey, A. & Luff, D. (2001). Qualitative Data Analysis. Published by Trent Focus. Lauritzen, C., Reedtz, C., van Doesum, K. T. M., & Martinussen, M. (2013).Workforce barriers to including a child perspective in the treatment of mentally ill parents. Submitted. Maybery, D., & Reupert, A. (2006). Workforce capacity to respond to children whose parents have a mental illness. Australian and New Zealand Journal of Psychiatry, 40, 657-664. Poncheri, R.M., Lindberg, J.T., Foster Thompson, L. & Surface, E.A. (2008). A Comment on Employee Surveys: Negativity Bias in Open-Ended Responses. Organizational Research Methods. DOI: 10.1177/1094428106295504. Downloaded from: http://orm.sagepub.com/content/11/3/614 Proctor, E.K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C. & Mittman, B. (2009). Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training Challenges. Adm Policy Ment Health (2009) 36:24-34. Doi: 10.1007/S10488-008-0197-4 Reedtz, C., Lauritzen, C., & van Doesum, K. T. M (2012): Evaluating workforce developments to support children of mentally ill parents: Implementing new interventions in the adult mental health care in Northern Norway. In press. Reupert, A., & Maybery, D. (2007). Families affected by parental mental illness: A multi-perspective account of issues and interventions. American Journal of Orthopsychiatry, 77, 362-369. doi: 10.1037/0002-9432.77.3.362 Rogers, E.M. (1995). Diffusions of Innovations (5 ed.). New York. The Free Press. Slattery, Voelker, Nussenbaum, Rich, Paniello & Neely (2011). A Practical Guide To Surveys and Questionnaires. Sage Publications. DOI: 10.1177/0194599811399724. Downloaded from: http://oto.sagepub.com/content/144/6/831 Solantaus, T., Paavonen E. J. •Toikka, S & Punamaki R. L. (2010). Preventive interventions in families with parental depression: children’s psychosocial symptoms and prosocial behavior. European journal of Child and Adolescent Psychiatry 19:883–892 DOI 10.1007/s00787-010-0135-3 The Ministry of Health and Care Services. (2009). Changes in the law, downloaded from
http://www.regjeringen.no/pages/2188713/PDFS/OTP200820090084000DDDPDFS.pdf on the 3rd of October, 2011.
Foto: : Colourbox.com
This study is a part of a large implementation study that evaluates the process of implementing the interventions Family Assessment and Child Talks for children of patients in the adult mental health care (Reedtz, Lauritzen and van Doesum, 2012). The participants in this study were staff and leaders at wards that are implementing the new interventions. The project was designed to evaluate the process of change in clinical practice, and a mixed methods approach was chosen. The data was collected via webbased questionnaires for all staff (n = 219), which generated both quantitative and qualitative data. This part of the study reports on the qualitative data (n = 183, n = 58), and the data was analyzed using a Framework Analysis approach (Lacey and Luff, 2001).
References
Table 1. (N = 58)
